Problem Statement

Claim edits create manual rework before a claim can go out the door, and edits left unresolved either delay submission or, if missed, produce avoidable denials that erode the clean claim rate and push out cash collection. Unlisted procedure codes won't bill without a written description, so each flagged claim requires someone to find the right description in a source system and paste it into the claim edit before it can go out. It's pure look-up-and-transcribe work, but until it's done the claim is held.

Automation Solution

This automation identifies claims requiring a procedure description, retrieves it from the source system, and enters it into the Claim Edit Assistant to support accurate claim submission.